Molecular Imaging of Inflammation in Atherosclerosis (original) (raw)
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Imaging Modalities to Identity Inflammation in an Atherosclerotic Plaque
Radiology Research and Practice, 2015
Atherosclerosis is a chronic, progressive, multifocal arterial wall disease caused by local and systemic inflammation responsible for major cardiovascular complications such as myocardial infarction and stroke. With the recent understanding that vulnerable plaque erosion and rupture, with subsequent thrombosis, rather than luminal stenosis, is the underlying cause of acute ischemic events, there has been a shift of focus to understand the mechanisms that make an atherosclerotic plaque unstable or vulnerable to rupture. The presence of inflammation in the atherosclerotic plaque has been considered as one of the initial events which convert a stable plaque into an unstable and vulnerable plaque. This paper systemically reviews the noninvasive and invasive imaging modalities that are currently available to detect this inflammatory process, at least in the intermediate stages, and discusses the ongoing studies that will help us to better understand and identify it at the molecular level.
Imaging Atherosclerosis and Vulnerable Plaque
Journal of Nuclear Medicine, 2010
Identifying patients at high risk for an acute cardiovascular event such as myocardial infarction or stroke and assessing the total atherosclerotic burden are clinically important. Currently available imaging modalities can delineate vascular wall anatomy and, with novel probes, target biologic processes important in plaque evolution and plaque stability. Expansion of the vessel wall involving remodeling of the extracellular matrix can be imaged, as can angiogenesis of the vasa vasorum, plaque inflammation, and fibrin deposits on early nonocclusive vascular thrombosis. Several imaging platforms are available for targeted vascular imaging to acquire information on both anatomy and pathobiology in the same imaging session using either hybrid technology (nuclear combined with CT) or MRI combined with novel probes targeting processes identified by molecular biology to be of importance. This article will discuss the current state of the art of these modalities and challenges to clinical translation.
International Journal of Molecular Sciences
Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different inv...
Molecular Imaging to Identify the Vulnerable Plaque—From Basic Research to Clinical Practice
Molecular Imaging and Biology, 2012
Cardiovascular disease (CVD) is still the leading cause of death in the Western World. Adverse outcomes of CVD include stroke, myocardial infarction, and heart failure. Atherosclerosis is considered to be the major cause of CVD and is estimated to cause half of all deaths in developed countries. Atherosclerotic lesions of the vessel wall may obstruct blood flow mechanically through stenosis, but rupture of atherosclerotic plaques causing formation of occlusive thrombi is far more prevalent. Unfortunately, conventional diagnostic tools fail to assess whether a plaque is vulnerable to rupture. Research over the past decade identified the biological processes that are implicated in the course towards plaque rupture, like cell death and inflammation. Knowledge about plaque biology propelled the development of imaging techniques that target biologic processes in order to predict the vulnerable plaque. This paper discusses novel and existing molecular imaging targets and addresses advantages and disadvantages of these targets and respective imaging techniques in respect of clinical application and socio-economic impact.
Vulnerable atherosclerotic plaque - a review of current concepts and advanced imaging
Biomedical Papers
Atherosclerosis is the most common cause of both carotid and coronary steno-occlusive disease. Rupture of an atherosclerotic plaque may lead to the formation of an overlying thrombosis resulting in complete arterial occlusion or downstream embolism. Clinically, this may manifest as a stroke or acute myocardial infarction, the overall leading causes of mortality and disability in developed countries. In this article, we summarize current concepts of the development of vulnerable plaque and provide an overview of commonly used imaging methods that may suggest/indicate atherosclerotic plaque vulnerability.
Molecular Imaging of Vulnerable Coronary Plaque: A Pathophysiologic Perspective
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2017
Atherothrombotic events in coronary arteries are most often due to rupture of unstable plaque resulting in myocardial infarction. Radiolabeled molecular imaging tracers directed toward cellular targets that are unique to unstable plaque can serve as a powerful tool for identifying high-risk patients and for assessing the potential of new therapeutic approaches. Two commonly available radiopharmaceuticals-(18)F-FDG and (18)F-NaF-have been used in clinical research for imaging coronary artery plaque, and ongoing clinical studies are testing whether there is an association between (18)F-NaF uptake and future atherothrombotic events. Other, less available, tracers that target macrophages, endothelial cells, and apoptotic cells have also been tested in small groups of patients. Adoption of molecular imaging of coronary plaque into clinical practice will depend on overcoming major hurdles, ultimately including evidence that the detection of unstable plaque can change patient management an...
Anti-inflammatory mediators for molecular imaging of atherosclerosis
European Journal of Nanomedicine, 2014
Nanomedicine, a young and innovative field, offers interesting approaches for diagnosis and treatment in personalized medicine. Myocardial infarction and stroke belong to the most important challenges in this context because an improved early diagnosis of individuals well before fatal clinical endpoints occur is urgently needed. The underlying cause of myocardial infarction and stroke is atherosclerosis, a chronic immune-mediated inflammation of the vascular wall involving monocytes, macrophages, T-lymphocytes, and arterial wall cells. Hence, an immense number of pro-inflammatory mediators have been investigated in the context of nanomedicine and atherosclerosis but, interestingly, only few anti-inflammatory biomarkers. Nevertheless, the anti-inflammatory axis is always present as a negative feedback if a critical inflammatory perpetuation destabilizes atherosclerotic lesions. Hence, we could show that the immune-modulating, antiinflammatory molecules, adiponectin and interleukin-10, are useful for molecular imaging of AS plaques. Based on recent publications in animal models of atherosclerosis, we strongly assume that the inflammatory "brake" mechanisms may represent an interesting new tool to specifically target the scenario of culprit AS-lesions. In this review article we discuss the potential of adiponectin, interleukin-10 and other anti-inflammatory active molecules like targeted liposomes and high dense lipoproteins towards this.